hormonal health insulin insulin resistance perimenopause women's health Jul 01, 2024

As you find yourself on the roller coaster of perimenopause, with symptoms making your day uncomfortable, it's easy to blame everything on the usual suspects: estrogen and progesterone. But there’s another player behind the scenes, subtly orchestrating more than you might realise.

It’s insulin, a hormone that's pivotal in managing not just your blood sugar levels, but also has an impact on most parts of your body, and thus how you feel during perimenopause.


Think of insulin as a key — one made by your pancreas, designed to unlock channels into your body’s cells, so glucose can move into the cell from your bloodstream, to be converted by the cell’s mitochondria (factories) into energy molecules. This process keeps your blood sugar levels from swinging too high or too low. Just like Goldilocks, your body craves that 'just right' balance for your blood sugar level to function optimally.

Insulin plays a crucial role in managing both high and low blood sugar levels to maintain that 'just right' balance crucial for optimal body functioning. When blood sugar levels start to rise after a meal, the pancreas secretes insulin, which acts like an usher, directing any excess glucose that the cells aren’t using right now, into various storage sites within the body.

Two storage sites, the liver and muscle cells, convert glucose into glycogen, a storable form of energy. Regardless of the quantity of our muscle mass, they can only hold up to 500g of glycogen. Once this capacity is reached, any additional glucose is directed towards the fat cells for storing.

The ability for our fat cells to expand as much as needed was a boon during our cave-dwelling days, allowing us to store energy during times of abundance to then survive periods of scarcity on. In modern times, though, this trait can be less beneficial, particularly when we’re trying to fit into our favourite jeans!

Conversely, when blood sugar levels drop, such as between meals or during extended periods without food, insulin secretion decreases, and the body begins to break down these glycogen reserves back into glucose. This release ensures a steady supply of energy to the body, keeping you functioning whether you're eating or fasting.

Once glycogen stores are depleted, your body will start utilising your fat reserves to generate glucose. It’s important to know that high levels of insulin inhibit fat breakdown (lipolysis), essentially putting a lock on fat cells and preventing the release of fatty acids into the bloodstream. This mechanism ensures that when energy is abundant, the body prioritises the use of glucose over fat, and the creation of more fat stores (lipogenesis) when glucose is in excess.

Unfortunately, when insulin levels remain chronically high, this block on fat breakdown can contribute to weight gain and difficulty losing weight. This is called insulin resistance.


Think of insulin resistance as a teenager who’s stopped listening to their parent. At first, you ask nicely for them to tidy their room, but they're absorbed in their phone and don't hear you. You ask again, a bit louder, but still, no response. It escalates until you’re shouting to catch their attention, and they’re like, “why are you shouting? You just needed to ask.”

Insulin resistance is similar. Your cells become the teenagers, ignoring insulin’s pleas to let glucose in. Your pancreas, playing the part of the increasingly frustrated parent, pumps out more and more insulin, shouting to be heard over the distractions.

The excess insulin contributes to your blood sugar levels getting stuck on a roller coaster of highs (spikes) followed by lows (crashes) as you have too much insulin circulating and then too much glucose is removed from your bloodstream to the cells or fat stores. As your blood glucose level drops, you’re more likely to experience cravings for simple (refined) carbohydrates like chips, chocolate, sweets/lollies, crackers, biscuits/cookies, soda/soft drinks, as your brain drives you to get some glucose into your bloodstream.

As the simple carbs hit your bloodstream, your blood sugar level spikes back up, and the cycle starts again. You may find yourself stuck in a cycle of being hungry every couple of hours if this is the case for you.


From my previous blogs about estrogen, you will be aware that we have estrogen receptors on all our cells, giving estrogen the opportunity to influence many of our cell’s functions. Estrogen impacts insulin’s activity, by enhancing our cell’s responsiveness (sensitivity) to it.

This is great, while we have robust levels of estrogen. But of course, in perimenopause and menopause, our levels are less predictable, and trending down overall. This means your body might not handle insulin as well, needing more of it to do the same job. That is, you tend to be more insulin resistant that you are in your younger years.

And this, dear reader, is part of the reason why it can be so difficult to lose weight in perimenopause and menopause, and why your energy and mood can tank too.



Navigating weight changes during perimenopause isn't just about what you eat, how much of it or how often you exercise. It's largely about your blood glucose levels and insulin. With decreased insulin sensitivity and higher insulin levels, your body tends to to be in fat storage rather than fat burning mode, making weight loss more challenging.

And often that fat mass that we're accumulating is visceral fat, which is very dangerous for us, predisposing us to more chronic diseases and long term illnesses. It's the fat that accumulates around your organs, around your liver , and abdomen there as well. Much more dangerous than the fat mass around your thighs or your arms.


Your thyroid, the master regulator of metabolism, also feels the effects of high insulin. Insulin resistance alters the conversion of your thyroid hormones, reducing the active thyroid hormone (T3) available to your cells. Less thyroid hormone affects every cell and system of your body - from your energy levels to your iron absorption.

The crossover between hypothyroid symptoms and perimenopause symptoms is great. Brain fog, weight gain, exhaustion, low iron, heavy periods, long cycles, poor memory and concentration, dry skin… it’s easy to write things off as being ‘just perimenopause’ when it could actually be something else. Without thorough testing and investigation, you will miss the opportunity to do anything about it before it becomes a disease or dysfunction. And please make sure that testing is analysed against optimal ranges, not just normal ones.


Insulin also plays a pivotal role in regulating reproductive hormones like testosterone. Elevated insulin levels can increase androgen (’male’ hormones like testosterone) production, which might contribute to changes in menstrual cycles and symptoms often associated with conditions like PCOS (Polycystic Ovarian Syndrome), even during perimenopause. High testosterone fuels insulin production too - so you can get stuck in a cycle that leaves you with long cycles, weight gain, and feeling agitated.


Ever feel like you're walking through a fog during perimenopause? It’s a common symptom, not just of perimenopause, or thyroid hormone changes, but insulin resistance may be at play for you too. High or low blood sugar levels are sub-optimal for your brain. Higher insulin levels can trigger inflammation, an immune response that drives cell and tissue damage. High insulin levels can also lead to low blood glucose levels, which can impact cognitive function, leading to feeling foggy, with memory lapses and difficulty concentrating.

If we think of the cells in our brain - the neurons - as little people dashing about our brain, searching through the filing cabinets of our mind to find the memory or skill that we need, it makes it easier to understand why not having enough blood glucose available to our brain cells would leave us having a hard time thinking, concentrating or remembering what we need to.

Metabolic flexibility becomes very important as we age, to help try and avoid this foggy state. This means your body, particularly your neurons, are able to switch easily between glucose and fat as a fuel source. Making sure your biochemistry is balanced - that is, your insulin and blood glucose levels - is key to this flexibility.


Now that we understand the crucial role of insulin and how it can be a double-edged sword during perimenopause, let’s get into some practical steps you can take to maintain your insulin sensitivity and enhance your overall well-being.


First, let’s do a quick self-check to gauge your risk for insulin resistance. A simple yet effective method is calculating your waist-to-height ratio. Here’s how:

  1. Measure your waist circumference at the narrowest point.
  2. Measure your height.
  3. Divide your waist measurement by your height.

If the result is 0.5 or higher, it may indicate insulin resistance, suggesting it's time to focus on balancing insulin levels.Please do check in with a qualified practitioner (like me!) or your GP for a more formal diagnosis.


What you eat, how you eat it, and when you eat, all play a pivotal role in managing your insulin levels. Aim to balance your plate at every mea, with the following ingredients:

  • Protein: Supports steady glucose levels and builds lean muscle.
  • Healthy Fats: Helps slow digestion, reducing blood sugar spikes.
  • Fibre: Aids in slowing the absorption of glucose into your bloodstream, keeping insulin in check.
  • Phytoestrogens: Found in foods like soy and flaxseeds, these can help balance hormones naturally.

Eating this way not only helps manage insulin but also supports overall hormonal balance, which is crucial during perimenopause.


Incorporate a bit of movement after meals to aid in glucose uptake by your cells and prevent spikes in blood sugar. This doesn’t need to be intense; a gentle walk around the block or even a fun dance session to your favorite song can make a significant difference.


I know, I know, it can feel impossible to reduce the stressors in your life. They just keep on keeping on. What can be easier to manage is focusing on your stress resilience. Building stress resilience is more crucial than ever as your natural stress-resilience hormone, progesterone, declines in perimenopause.

Daily self-care habits are key to building stress resilience. It’s not all meditation, gratitude and mindfulness (though these are all wonderful self-care!). The basics of self-care in my view include movement, safe sun exposure, nourishing meals, quality sleep (and enough of it), staying hydrated, being in community, and doing something that brings you joy or makes you laugh, Every. Single. Day.

Focus on enriching your life with:

  • Connections: Social interactions can boost your mood and immunity.
  • Joy: do something everyday that brings you happiness and joy. Did you know that laughter, and having fun, release your feel good hormones, endorphins, which help reduce feelings of stress and worry?
  • Adequate Sleep: Ensure you get enough restful sleep as it helps regulate hormone levels and improve insulin sensitivity.

Remember, self-care doesn’t have to be a grand gesture, or big event. Small consistent changes can lead to significant health benefits over time. Don’t beat yourself up if you don’t get everything right the first time you try. Just try again the next day.


If you suspect insulin resistance is playing a role in your perimenopause symptoms, or if you're looking for more advice and tips on how to optimise your health with the right nutrition and lifestyle adjustments, consider joining the waitlist for PerimenoGO. Being on the waitlist not only secures your spot but also gives you access to the super special (never to be repeated) founders price when it launches on 15th July

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Remember, you have the power to influence how you experience perimenopause and beyond.

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